Not Near Enough: Racial and Ethnic Disparities in Access to Nearby Behavioral Health Care and Primary Care

Wielen, Lynn M. Vander; Gilchrist, Emma; Nowels, Molly; Petterson, Stephen; Rust, George; Miller, Benjamin F.

doi:10.1353/hpu.2015.0083

Cited by 56 publications

(33 citation statements)

References 54 publications

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“…Other mechanisms of delivery, such as telehealth, could have made the program more accessible. Second, patients with fewer resources and greater social disparities are not as likely to access health care or participate in research ; our results are likely biased because of the difficulties of including diverse participants. Third, we had multiple surveys that represented response burdens to some participants who continued in the program (but did not complete the forms).…”

Section: Discussionmentioning

confidence: 96%

A chronic care ostomy self‐management program for cancer survivors

et al. 2016

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Background Individuals with ostomies experience extensive changes in health-related quality of life (HRQOL) and daily routine. Patients and families are typically forced to use trial-and-error to improve self-management. Methods This is a longitudinal one-group design pilot study of a five-session ostomy self-care curriculum based on the Chronic Care Model to improve HRQOL and self-management for cancer survivors with ostomies. Participants were surveyed to evaluate each session. Multiple instruments were administered to examine outcomes at baseline, post-intervention, and at six-month follow-up (Patient Activation Measure, Self-Efficacy, Hospital Anxiety and Depression Scale, Ways of Coping, Group Health Association of America Satisfaction with Ostomy Care Survey, and the City of Hope Quality of Life - Ostomy). Changes from pre- to post-intervention and pre-intervention to follow-up were evaluated with paired t-tests. Text responses were coded and evaluated for important themes and recommendations. Results Thirty-eight subjects participated in the study. Most had a history of rectal cancer (60.5%) or bladder cancer (28.9%). Participants rated the overall program high (4.4–4.8 on 5-point scale). Text feedback indicated that participants enjoyed the group forums, wanted more participants, and more hands-on training. Scores on multiple surveys were shown to be improved and sustained, including Patient Activation (p=0.0004), Self-Efficacy (p=0.006), Total HRQOL (p=0.01), physical well-being (p=0.005), and social well-being (p=0.002). Survivor anxiety was significantly reduced by follow-up (p=0.047). Conclusions This self-management ostomy program can help cancer survivors with ostomies adapt to their stoma. Initiating this program in the community setting would be beneficial to many cancer survivors.

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Section: Discussionmentioning

confidence: 96%

A chronic care ostomy self‐management program for cancer survivors

et al. 2016

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“…Thus, much of the disparity in mental health outcomes across racial and ethnic groups can be explained by socioeconomic status and other neighborhood-level factors such as segregation, social isolation, and exposure to violent crime (Williams andEarl, 2007, Alegria et al, 2015). Further, research on mental health service has shown mental health services are less available in neighborhoods with higher racial and ethnic minority populations, making it more challenging for minority populations to receive treatment (VanderWielen et al, 2015). Stigma and mental health education may also play a role in racial and ethnic disparities in treatment (Batterham et al, 2013).…”

Section: Race and Ethnicitymentioning

confidence: 99%

“…Socioeconomic variables included mean household income, poverty, unemployment, and low educational attainment (Spady et al, 2001;Amone-P'Olak et al, 2009;Reiss, 2013;Center for Behavioral Health Statistics and Quality, 2016). Demographic variables included race, ethnicity, divorce, single parent homes, population density, and Rural-Urban Continuum Codes (RUCC) (Sen, 2004;Hempstead, 2006;Akhtar-Danesh and Landeen, 2007;Alegria et al, 2015;Fontanella et al, 2015;VanderWielen, et al 2015;Nestor et al, 2016). Residential stability was measured using renter-occupied homes and individuals living in a different home during the past twelve months (Cutchin and Churchill, 1999;Barkan et al, 2013).…”

Section: County-level Explanatory Variablesmentioning

confidence: 99%

“…Crisis hotlines have demonstrated effectiveness at reducing crisis severity, feelings of hopelessness, and suicidality Gould et al, 2007). Prior research has demonstrated that a variety of demographic, socioeconomic, and environmental factors can influence the prevalence and severity of mental distress and whether an individual is likely to receive treatment (Barkan et al, 2013;Reiss, 2013;Fontanella et al, 2015;VanderWielen et al, 2015;Center for Behavioral Health Statistics and Quality, 2016;Nestor et al, 2016). The present study seeks to evaluate whether these same disparities exist for a ubiquitous, technology-based crisis counseling service.…”

Section: Introductionmentioning

confidence: 99%

“…Adolescents are particularly vulnerable to mental distress-approximately one-half of chronic mental health disorders begin by the age of fourteen, and three-quarters begin by the age of twenty-four . Populations with a history of being underserved (i.e., those with lower socioeconomic status, racial and ethnic minorities, and individuals living in rural areas) experience elevated risk for mental distress and are less likely to receive treatment or engage in help-seeking behavior (Barkan et al, 2013;Reiss, 2013;Fontanella et al, 2015;VanderWielen et al, 2015;Center for Behavioral Health Statistics and Quality, 2016;Nestor et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Adolescents in crisis: A geographic exploration of help-seeking behavior using data from Crisis Text Line

Thompson

Sugg

Runkle

2018

Social Science & Medicine

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Prior research has demonstrated that a variety of demographic, socioeconomic, and environmental factors can influence the prevalence and severity of mental distress and whether an individual is likely to receive treatment. Behavioral health research has been limited to self-reported survey data, but advances in technology have provided increased opportunities to continuously capture and store data, and to learn about the help-seeking habits of its contributors. In response to the growing prevalence of technologically mediated crisis counseling services, this county-level ecological study evaluated whether these same disparities exist for help-seeking via Crisis Text Line, a free, ubiquitous, technology-based crisis counseling service. Because most suicide attempts are impulsive acts, crisis hotlines are often the only resource available to suicidal or at-risk individuals. It is critical that researchers and practitioners are aware of any population-level disparities limiting the use of these invaluable resources. To date, this is the first study to examine text-based help-seeking behavior among adolescents at a national scale. Results identify several factors associated with increased or reduced help-seeking behavior among adolescents in the U.S. Increased v rates of CTL usage occur in counties with higher mean household incomes, higher divorce rates, and lower residential stability. Rurality was the strongest predictor for low rates of help-seeking, and this finding is particularly concerning in light of elevated rates of suicide among rural counties. Low rates of help-seeking compound ongoing rural-urban disparities in traditional mental health services, and this finding suggests that increased suicide risk in rural areas cannot be explained by mental health professional shortages alone. Rural communities, particularly those with low support-seeking behavior and comparatively high suicide rates, should be the target of future research and outreach.vi

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Community Health Workers and Social Proximity: Implementation of a Parenting Program in Urban Poverty

Gustafson

Atkins

Rusch

2018

American J of Comm Psychol

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Community health workers (CHWs) offer a potential means through which to mitigate many of the barriers to mental health services faced by minority youth and their families. The primary aim of the present study was to better understand a core feature of CHWs: their shared community membership with the population served, or social proximity. We conducted qualitative semi-structured interviews with 16 CHWs implementing a school-based early intervention program in Latino and African American communities of urban poverty. The program promoted child and parent/caregiver engagement in schooling as a protective factor for children's mental health. Thematic analyses revealed three main themes defining social proximity: (a) experiences of parenthood or caring for children, (b) familiarity with and understanding of culture, and (c) experiences of life hardships and struggles. Additionally, the process of relating with parents/caregivers through shared experiences was the main theme to describe how CHWs leveraged their social proximity. CHWs' accounts illustrated how their experience of social proximity to the population served was central to how they engaged parents/caregivers in services, highlighting the importance of supporting and promoting CHWs' natural traits and lived experiences.

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Not Near Enough: Racial and Ethnic Disparities in Access to Nearby Behavioral Health Care and Primary Care

Abstract: Background-Racial, ethnic, and geographical health disparities have been widely documented in the United States. However, little attention has been directed towards disparities associated with integrated behavioral health and primary care services.

Cited by 56 publications

References 54 publications

A chronic care ostomy self‐management program for cancer survivors

A chronic care ostomy self‐management program for cancer survivors

Adolescents in crisis: A geographic exploration of help-seeking behavior using data from Crisis Text Line

Community Health Workers and Social Proximity: Implementation of a Parenting Program in Urban Poverty

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